Interlaminar Distance and Bony Landmarks in Lumbar Neuraxial Anesthesia: A Concordance Study
Main Article Content
Keywords
Ultrasonics, Anatomic Landmarks, Spinal Puncture
Abstract
Abstract
Background: Accurate identification of the puncture site in neuraxial anesthesia is essential. Accordingly, this study examines the concordance between interlaminar distance and bone landmark palpation in cases of difficult blockade.
Objective: To reduce the risk of complications by enhancing the understanding of lumbar anatomy.
Material and methods: A concordance study was conducted in 90 patients scheduled for neuraxial anesthesia, using bone landmark palpation and ultrasound measurement, with descriptive and inferential statistics applied through Cohen’s Kappa coefficient.
Results: The agreement between interlaminar distance and difficult blockade was κ = 0.565, p = 3.07×10⁻⁸; and between bone landmark palpation and difficult blockade was κ = 0.308, p = 0.00086. The odds ratio between difficult blockade and bone palpation was OR = 5.71 (95%CI: 1.93–16.93); for interlaminar distance and difficult blockade, the OR was 19.5 (95%CI: 5.85–65.00). The probability of encountering a difficult neuraxial blockade using the clinical technique was 80.77%, and with ultrasound guidance, it was 57.78%.
Conclusions: An interlaminar distance <1.38 cm and grades 3 or 4 show moderate agreement with difficult blockade. Grades 3 or 4 were associated with a 5.71-fold increased likelihood of encountering a difficult blockade, whereas an interlaminar distance <1.38 cm was associated with a 19.5-fold increase. Based on probability difference, the use of ultrasound prior to neuraxial blockade reduces the likelihood of technical difficulty by 22.99% compared to the traditional clinical technique.
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